This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Wednesday, 20 January 2010

How does it keep getting worse? Total Insanity.

Our staffing levels and skill mix continue to be a joke- a sick fucking joke.

I thought that we were slated to get some new staff nurses. I was wrong. We are getting more kids to replace the ones we are losing. They really are kids and they have no training or experience in a health care setting. They will not be trained or orientated. They will show up to work and just have to muck in, without knowing what they are doing. No one has time to explain or teach anything. The kids from last year are still fucking a lot of things up. Goddammit I want RN's. I can't handle being a nurse for this many patients whether I have 5 carers with me or fifty of them. 90% of what is going on in a ward is way over the care assistants heads. They just don't realise it.

A nice little surprise awaited my arrival onto the ward to work a day shift recently. I'm not talking about the staffing levels. Those were as shitty as expected for the shift. We were going to have 3 staff nurses and 2 carers. But they sent our third staff nurse to cover another short ward. So we had 2 staff nurses and 2 carers. And then they sent us this agency carer who cannot speak a word of english and has been in the country a short time. No previous experience in healthcare. But she was wearing a nice pretty uniform that says "Nursing staff" on the front. No wonder the patients and the visitors are confused. I told her not to leave the cdiff mrsa patient's room without washing her hands. I told her not to share equipment between those patients and other patients on the ward. She gave me a beautiful smile and said "yes matron" to me and kept going. She did the same thing again 2 minutes later.
I think the only words the poor child knew were "yes matron" and "I happy to". Not a clue about what we were saying to her. Not a clue. Sweet girl though. I did complain to the site manager about it. Her response was "you should be grateful for having an etc set of hands". Uh, you took our trained nurse away and gave us a total novice.

Just for the record (in case any fucktwits are reading this) that girl is NOT a foreign nurse. Foreign nurses have education, qualifications and registration with the NMC. This girl was not a nurse and not registered with the NMC. She was a foreign employee, not a nurse.

So those were our staffing levels.

Back to my surprise. There was a list of "orders" orders from management that greeted me when I arrived for duty.

They wanted us to take apart a whole lot of equipment and clean it all, on the floor on our hands and knees. They wanted us to assess all these things for faults and fill in about ten forms for each item. I am talking about large items like beds, mattresses, etc. They wanted this from 2 staff nurses and three carers covering 25 patients who all require constant care. They don't want to pay domestics, but they don't want another Basildon. They don't want to hire nurses or staff nor do they want to be in the papers. I was told that threats had been made against the nursing staff if these things are not done. Look at how basildon hospital responded to complaints about the care at their hospital. They know what the situation is , but they blame the nurses.

In a letter to Mr Wood's family he wrote: "I am sorry that the standards of cleanliness were unacceptable during your father's hospital stay. All the clinical areas should be cleaned daily. There is no excuse for dirty bed linen to be left in the lavatory. The ward would like to apologise that the care they gave has left your family feeling that expected standards of care have not been met."

Now I am all into cleaning and stuff. I quite enjoy the whole domestic goddess thing. But what I couldn't figure out was this: who the fuck is going to take care of the patients?

We worked out how long it would take to knock out all the things on the list. It would take 6.5 hours out of an 8 hour shift. They wanted it done on that shift. It takes about 6.5 fucking hours to get through the 8 AM drugs for a ward full of confused and acutely ill patients.

We have many, many patients all sharing two toilets and management also demanded that we spend 8 minutes exactly scrubbing out each toilet between use. Then they wanted a form filled in and signed after each and every cleaning session. How? How? At any given time we have more patients that need the toilet than there are toilets. And they get real nasty if they have to wait. Really nasty. We worked out that we would have to spend 50 minutes out of every hour just scrubbing toilets in order to do what tthe powers that be wanted. It usually takes the care assistants (with the help of a nurse when she finishes the work that only a nurse can do) until about 1PM to finish all the AM hygiene etc for the patients when there are 6 of us on duty.

So they wanted this all from us without any additional staff. When RN's don't spend enough time with patients and focusing on the things that only a nurse can do patients die. Those things are all encompassing and take more time than we have. What are these managers thinking?

Stupid us we tried to accomplish it. My vote was to send an incident form to management saying "direct patient care and patient safety comes first, this is impossible so fuck you". But the other staff nurse on duty outranks me and she is a Nerdy Nellie, always wants to please. They had threatened us with a spot inspection that shift. We had to make a go of it. It was a disaster.

So by 10 AM I am 1/3 of the way through my 0800 drug round. Half my patients are spitting their meds out on the floor or refusing to take them. Half the beds are half dismantled. The phone is ringing nonstop and we are having to drop what we are doing to answer it, otherwise the public complains that we aren't "bothering" to answer the phone. And it's at this time that one of my patients goes bad.

The drug I need to stop the "bad" is always supposed to be kept in the fridge. It wasn't there. This is happening almost every day. Pharmacy has no staff either, and they are never open when we need them. If something isn't there it is the nurse's problem. Problem was, they left us without an emergency drug and they were closed. My other staff nurse had an emergency on her side. The two care assistants were half way through bathing a patient who requires two people spending 20 minutes with her to get it all done. The other staff member couldn't understand english, although she did show concern over the fact that I was standing in the medication room in a rage.. I had to ring 7 wards to find the drug and then walk my bottom down there to get it. But I got it, and patient survived.

When I got back to the ward it was still chaos. Patients were crying because they wanted to get back into bed. But the beds were all apart waiting for the staff to check them over and copy equipment numbers that are located in hard to find places. It all was ordered to be done in the morning. And there was so much going on that there was no way we were getting back to those beds. I went to help Nellie with her poorly patient once mine was okay. My drug trolley was just parked in the middle of the ward. Patients were getting concerned that their drugs were so late and that they couldn't even crawl back into the bed to deal with the pain. I reminded Nellie that the dismantled beds were her fault and that we should have gone with my incident form idea. Ha.

Nellie's patient now had a pulse of 200 but was alert and comfortable. All other vitals were fine. The phone rang. I answered it hoping that it was the registrar (senior doctor) I had just paged about Nellie's patient. I thought for sure it would be him calling back. But it wasn't. It was Mrs. Jones daughter screaming at me because her mother phoned her to tell her that she hasn't had her morning meds yet. I told her that I was in the middle of an emergency and that I needed the phone line free NOW. I told her that I would get her mother her tablets as soon as I could. It went over her head. She kept threatening me. If the senior doc was ringing us back he wouldn't be able to get through because this woman was keeping the line engaged with "Don't you fucking tell me that you couldn't find time in the last two hours to give my mother her pills". I had to hang up on her. We have one working phone line. Then I heard a shout from Nellie and the next thing I knew I was putting the crash call out to get the cardiac arrest team to us immediately. Her patient had just crashed. We didn't get her back.

Later on in the day I had more family fun with my patients relatives. I had a patient on a drug that needs to be given at regular intervals through out the day. I managed it but one of the doses was 10 minutes late. No big deal. Two hours late would be a problem but not ten minutes. I have looked after thousands of people on this drug. Her husband decided to give me a lecture and a computer print out from the internet about that particular drug because "you nurses are obviously too stupid to know that it needs to be given on time". How he could think he understood WHY that drug was late. He didn't have a clue as to what was going on in that ward. I should have got a fucking award for getting it to her when I did. That on it's own, took a lot of manuevering. If your loved one has a drug due at 0800 so do many of the nurses other patients. Getting everyone everything on time is physically impossible. I would have to be in 15 places at once literally. If I have say, 10 patients all due a drug at 10 AM I will start at 9:30 with the first one and get to the last one at 10:30. And run past people calling for help to accomplish that. There is no other way.

It just got worse as the day progressed.

We had some fun with the doctors as well. . Some of them are just creepy. The first thing that happened was a surgeon showed up onto the ward to see one of my patients. He wasn't her main doctor but he was asked by her doctor to see her. He arrived on the ward unexpected shortly after the cardiac arrest. The aftermath of one of those things is massive. He went over to the patient and when she told them that she hasn't seen a nurse in hours he responded with "have you complained about anything-they'll be extra mean if you complain". I wasn't surprised. My patients have told me that many consultants tell their patients this. In all my years of nursing I have never seen a patient get treated extra badly because they complained. Never. Everyone gets neglected whether you are nice to the nurses or not.

About a half an hour after the cardiac arrest a relative called me. She asked me if I would give her mother a bath and wash her hair in the next hour, before visiting. I looked at the ward in disarray and remembered that I was hours behind with about 1000 crucial jobs. She wanted her mother to have an hour soak in the bath. This would require a member of staff staying with her for an hour as she cannot be left alone in there. The other 4 members of staff were doing about 20 jobs per second, other patients were crying out for help and were being ignored. The ward was a mess. No one could take the dirty linen away.The non english speaking staff member would not be able to get this woman in the bath safely as a hoist thing was required. None of us had the time to show her. I had this girl specialing a confused wanderer that was trying to get out. I told the caller that I would probably be unable to get it done today because of ward conditions. She went onto tell me how important it is for patients to have simple things like their hair washed and how nice it is to do something like that for someone. I was perplexed. How could she think that I, a registered nurse, could not understand something like that.

Ask any patient who has been in hospital unable to care for themselvs what meant the most to them while they were there. They won't say it was the doctors or nurses, nor appreciate the meds or the treatments or the labwork we did. They will tell you that the number one thing that they appreciated was a bath and a hair wash. I have known this since 1992. Of course it is a wonderful and important thing to do for patients. Things like that actually help patients heal because they feel positive when they feel that they look nice. But the other other things going on at that time were all time consuming and higher priority. It dawned on me that she didn't understand that. She thought that I simply didn't want to be bothered washing her mother's hair. She thought that nurses these days don't understand the importance of the simple things. It is a triage situation on these wards, and the public have no idea. And they are conditioned to think that nurses are uneducated slags who don't want to be bothered. I have no chance of getting the reality of the situation across to her. She has been socialised to have completely unrealistic expectations from the nurses. I told her I would try my best (and I did ) but I didn't think I would be able to. I left it at that. She wasn't happy.

I got out of there over an hour and a half late, unpaid. And not one job was completed properly. I heard later on that it got even worse.

On my way out I was greeted by a nice person, the partner of a long term patient who is bedbound and unable to care for himself following a RTA (info changed to protect confidentiality). This patient was medically stable but needed much in the way of total nursing care. He has been with us a long time and comes in frequently. We adore him and we adore the family. We know them well. The spouse handed me some chocs and says " I just wanted to say thank you for everything you have done for soandso, you nurses are amazing".

Just what had I done for so and so? I hadn't laid eyes on him in 5 hours. I spent about 2 minutes helping the care assistants wash him and had a quick look at his skin. I resited his venflon. I gave his IV meds an hour late. I ordered an airmattress. That was all. I didn't have time to spend with him and didn't do half of what I should have. I was in and out of that room at the speed of light. It makes me sick. The spouse knew this because she was there. She knew we were having a rough time and was trying to build us up. The tears were about to start so I walked away mumbling yeah thanks.

So can see if you are mean to the nurses we get upset, and if you are nice, we get upset. You are not going to win really.

What a mess. Our staffing numbers look like crap over the next few months and management is hellbent on this cleaning regime and associated paperwork. Some of the stuff they want done multiple times daily. They won't even consider bringing more domestics in or giving us someone to answer the phone. We have one shift that is set to be staffed really really well. And that means that a staff member on that shift will be sent elsewhere.

I just have one question. "How?"

I am hearing through the grapevine that frontline staff nurses are set to be scapegoated if anything goes wrong with the cleaning etc. They are all ready all over us for the cleaning forms not being filled in. It doesn't surprise me after reading this.- nurses being questioned by police. The physical layout of the ward does not allow for patients to be isolated properly, we don't have enough handwashing stations etc etc, we cannot even wash our hands properly without getting told that we are not responding to patients quick enough. Sometimes I will just turn on the water to wash my hands after finishing with one patient and the patient in the next bed will start shouting. "get over here now and get me the toilet" "I am just need to clean the commode and wash my hands and I will be right there" "Get over here now or I will wet the bed and it will be your fault". Imagine if I took the time out to fill in the form saying that I cleaned the commode during that scenario.

We are not up to date with our knowledge. Meanwhile David Cameron is running around like a twat worried about overeducated nurses not wanting to care for the patients. The problem is no nurses David, not education of nurses.

Half my shift is spent at the nurses station sorting out systems problems or running around the hospital looking for drugs anyway. Can't wait to get out of here.

75 comments:

No matter how bad it gets Anne, you got to record this, Got to keep writing it all down, and Save it too. One day ONE DAY someone will learn from this. The world has GOT to know. I am sure the last thing you want to do is rake up all this pain and carry on writing. I hope you record all this someplace else and its not just ether on the bloggosphere. since the beginning of time really evil things have happened, and eventually we learnt from them........... or at least taught our children about them, At least we dont forget them.

but only because SOMEONE bothered to write it down.

right now I guess you feel as far removed from a nurse syringing hydorgen peroxide onto a stump of a screaming young man in the trenches, of a helpless mother watching her family die of Cholera or plague, of a nurse turning up on an early shift in Scutari only to find there is no clean linen. Of the prison nurses in The Maze in northern Ireland Nursing hunger strike patients, of the nurse in Bedlam, of the soldiers who were told to muck out the wards in Belsen, of the people who tried to patch up the gladiators during a circus in ancient Rome, of the ancient Egyptian orthopaedic nurses, ministering to yet another bad back. but someone wrote their story..............and now you must write yours.

Totally ridiculous, but something I can relate to! In our A&E Department, we have a clipboard full of paperwork with boxes to tick, for each and every object in the whole department to be cleaned on a daily basis. If these boxes aren't ticked, the nurses are in big shit.

i.eevery patient trolley to be stripped down to pieces (difficult when they are rarely empty), every day and disinfected.

every piece of monitoring equipment in the department including obs machines, defibs, thermometers, BM boxes, ECG machines etc etc...to be disinfected every day.

All desk spaces, nurse base and offices to be stripped and cleaned every day, including cabinets, phones, shelves etc

All notes trolleys (3) to be emptied and cleaned every day.

Drug cubboards (there's 5) to be emptied and cleaned out twice a week.

The fluid trollies (huge and full of heavy boxes) to be emptied and cleaned out once a week.

The sluice to be stripped out and cleaned daily.

All chairs in dept to be wiped down daily.

The list goes on....

In theory, all of this is excellent. No bugs could survive this fantastic cleaning regime. My big issue, is that who's meant to be looking after the patients while the nurses do all this cleaning?

The cleaners?!

Nope. They're only expected to mop the floors and empty the bins.

Every day I get so pissed off with patients being prioritised second to cleaning. And when the complaints come in, cos "Aunty Doris had been in A&E for 2 hours and wasn't even offered any lunch!", then I wish management would tell them "No, the nurses have to much fucking cleaning to do to be taking any notce of Aunty Doris!"

The woman who demanded that her Mother have an hour's soak in the bath.Very simple answer to that one - SHE should do it. Of course you'd need to get the patient into the bath with the the hoist and perhaps provide a panic button/pager for the daughter . There would be serious benefits to the nursing staff, the patient, AND to the daughter providing direct loving care combined with a visit. Ask any psychologist. Medical reasoning permitting that is. Another matter is that there are nearly 1m unemployed 16-24 year olds. A bit of a risk I know but it seems to me that in return for job seeker allowance these kids could get some ACTUAL useful work experience, self respect,perhaps even respect for others, and understanding of the real world. A sort of National Service.At least they'll speak English (well a version of it) and the Trust would not be paying over the odds to employment agencies for immigrants who are untrained and don't speak English. the Trust would actually SAVE money.

From personal observation though I could well be wrong because at least some of the unemployed youth are not receptive to orders and authority and are lazy "know it alls" whose main objective is to SKIVE. Then again if only 10%.....There ARE loads of unemployed managers and professionals,and others, including Doctors, who could be given a supervisory role , at relatively little cost, for these people and who would likely be very happy to have even a temporary job. A few MORE beds would allow removal of existing to a disinfecting area and immediate replacement with freshly cleaned ones. The cost would be miniscule.OK I KNOW that maintaining the "clean" status would require some more thought but you get the general idea I'm sure. Clearly the very highly paid "management" of your hospital are just box tickers devoid of creative thinking. I despair. They are paid SO much just for keeping the Board happy. Been there, done that, but not in hospitals.

Maybe the above are bad ideas and I bow to your better experience (I'm only a retired Management Consultant so what do I know). Maybe both ideas could, with more work and thought, be seriously beneficial but the second one would require a serious political decision. EXCEPT of course that your Trust COULD (if the CEO has any bottle at all) negotiate with the DWP and the unemployed to achieve it. Unions permitting of course!!!!

Just a couple of thoughts. Pretty clear though that YOUR situation is nothing like Casualty where nurses, and doctors, seem to have lots of time for non medical activities!I happen to have been born just 7 miles from where Florence Nightingale was born and I seriously value medics and find your situation Anne totally appalling. Keep telling it how it is.

As a Management Consultant I would actually have buttonholed you as a valuable information resource. then again I would have hardly needed to do that because you so eloquently record what actually happens so I already got the idea. You almost encourage me to come out of retirement!!!

Her comments? "Why are senior midwives having to spend hours on the phone trying to find beds on the post-natal wards for patients instead of dealing with the mums and babies?" (my daughter waited in recovery from 4.30pm to midnight to get onto a ward), and "why are midwives/nurses having to steal suitable beds (literally) from each other's patients?".

Anne, I've got a problem, I think it's a mental problem. Currently, I'm working in a medical specialty which isn't general medicine and don't have to suffer all (although some) of the frustrations you suffer. I'm a doctor. I should be happy by now. I should be able to read your blog and think thank the lord I left to do something else. But I can't. Because I remember every little victory, every time we managed to get one over on the system and I miss it a lot. Keep on going, don't turn your back on it, don't give up, because the more I'm away the more I want to take the bastards on one more time. And keep on blogging, it's very informative to doctors. You may be angry, but you manage to be a little diplomatic and get some of doctors (BTW where is the exciting place of philandering and cocaine?) on your side. Remember management loves divide and rule.

I don't know if it's appropriate to ask a question on the comments bit, but just when did cleaning become the nurses job again? When I was in college the first time around (about 1990) my friend used to spend her summers as a cleaner at Papworth. She used to clean blood & bodily fluids and have hep shots.

I'm in the USA now but our cleaners will stop us in the hallway as we're running to a patient to tell us to clean up some poop/vomit/blood somewhere as if we are standing around with nothing better to do.

Where is your Director of Nursing? He/she is professionally accountable for the quality of Nursing care. Swanning around the Conference circuit? Overseas Study Tours? Up at the Department of Health advising useless civil servants? On secondment somewhere? Off on longterm sick?

What you are describing is unsafe care. At Maidstone and Tunbridge Wells they wiped out the Board, Chief Exec, Medical Director, the lot for stuff like this. There are very well paid people sitting around munching hobnobs who should be ensuring you have proper Resources to do your job. Its not inevitable, it doesn't have to be like this.

And where are the Commissioners - the Primary Care Trust that pays for this shitty care? Do they even know - I bet they claim no-one has told them. Get them out of meeting rooms, off their wellpaid arses and sort some proper funding.

Its like being in a car. Shouting at it wont steer it. You have to push the right pedals, turn the bloody wheel. Its all sitting there idly waiting.

To the Anonymous Doctor, you have the POWER to get one over on the system! The nurses don't! And a lot of that CAN be blamed on YOUR colleagues who do not respect or listen to nurses! To talk to Anne about staying on in that kind of hell (that you've managed to remove yourself from, you hypocrite) is irresponsible! If you miss it so much, quit whining and reminiscing and GO BACK!!!!!The nurses have been oppressed and kept down for decades due largely to your kind. To the consultant, it is your kind who have made hospitals so freaking impossible to work in by convincing the hospitals to make inhumane cutbacks - out of the nurses' hides! So now you say Anne is a valuable resource? Puleez! I'm just so angry I don't know what else to say! It's NOT going to get any better! It may get worse, but not better! Your country is lucky to have ANY nurses at all! Sounds like a lot of the people in the UK don't deserve their nurses because they treat them so atrociously. Keep writing, Anne! And PLEASE get out of that sweatshop as soon you humanly can!

I hear you sister!!! The NHS is a total joke and like working in a third world country, I know I come from one. It is like working in a sweat shop, only that you are accountable and have people's live in your hands. Its always the nurses fault. God I wish that everyone would wake up and see what a mess it is and how truely dangerous it is to be a patient because staffing levels are a total joke! I applaud you for turning up to work in that environment each day. Something has got to give!! Keep writing this down, you have something real to say!

Bill, I am only a bitch when I need to be. The conditions Anne and her colleagues are forced to work under do mimic third world sweat shops. And the UK journalists and the general public are blaming the nurses for a situation they are forced to work in and did not create. It makes me furious! It makes my head want to explode! How can a nurse be expected to take care of ten to fifteen patients - and clean? Environmental Services should be responsible for the cleaning. Not the nurse who is trying to monitor patients, pass medications, assess her patients, and handle transfusions. It isn't safe. SOMEBODY should be a bitch over this. And the consultants have mangled care by continuing to recommend crippling cutbacks that slashed nurse staffing and made the hospitals the hell to work in that they are. I'd like to see these consultants come in and try to actually implement what they recommended. So yes, they have betrayed nursing and patient care. And yes, the doctors have, too. They have done this by refusing to listen to nurses, establishing verbally abusive communications which effectively shut down all communication. Nurses do not want to report changes in condition if they know they are gong to be cursed out and called everything but "Ma'am". No, I'm not a bitch. Just absolutely fed up with the situation. The public should be demanding sweeping change, starting at the top. I'm not used to blowing a gasket like I did in the previous comment. I'm normally very reasonable and even-tempered. But this is ridiculous. How come so many people in your country don't get that? And instead of pointing the finger at me, why don't you do something to help Anne and the rest of the nurses in your country? Write your rep and demand decent conditions for nurses AND patients?

Anonymous was right when she said that the doctors helped to create this hell situation. But nurses have as well by not promoting our own worth. We don't explain what nurses do very well. The public is at fault because they don't value nursing but how could they possibly understand the situation when their only exposure to nursing is TV dramas?

Spot on, Anne! And it is our profession's fault, too, for not informing the public about what we do. But I think it is also the fault of the nursing educational system. I got spoon-fed the bunk about us being self-sacrificing and self-effacing. But when you grow up, it is only right to want to be appreciated and valued for the work you do. Everyone wants to matter. It's time to toss the sentimentality and treat nursing as the science it is - and give it the respect it deserves and has never gotten. And that will mean deprogramming a lot of the older instructors.

My girfriend is a psychiatric nurse in Germany and has much the same things to say Anne. Counterproductive paperwork and staff being nibbled away until it´s critical. One person on a night shift with a completely fucking stupid new personal alarm amongst a ward full of potential suicides or psychosis. She is scared, concerned and doesn´t feel she is doing basic things she is trained to do. Dissenters or critics are mobbed or moved to humiliating jobs which are not suitable considering their experience or qualifications until they usually go of their own accord. The curious doublespeak of `quality management teams´ and gagging of people using marmalade tactics, blaming the very people who aren´t sitting on fat bonus´s and are in the front line. I don´t know how she or you do it, it´s not the Falklands. It´s daily life. It´s not even as if the money is much good. I also urge you to keep writing, it´s a social crime.

Nothing changes and thats the sad part. Even in the ICU where we supposedly have one-to-one care, without agency staff we would be crippled. Agency RNs who are earning 3 times as much as our regular RNs but cannot do IVs or alter vent settings etc...Now I have been informed that we are over our agency budget (again) so will have to have Fuckwit Agency rather than Specialist Agency for the next six months. As for cleaning- the Trust has yet again changed the tender so we have less cleaners in nice new uniforms (that look just like HCAs) who don't even empty the bins and you'd have to look very hard to see if the floor has been mopped. We also have tickboxes for daily cleaning which is a joke-no-one is saying that cleaning isn't important but in the grand scheme of things, surely it makes more sense to have RNs doing NURSING so that granny does get her hair washed and the cleaners doing CLEANING? Its not rocket science. On a plus note, one of our senior corporate nursing officers came down to the MAU last week (long story but I was having to cover for one of the floor sisters who was off having a mental breakdown) and just as she was being rushed past the messy patients who were rolling around and bleeding/puking all over the floor to see the "Very interesting NEW Piece of technology" one of the aforementioned patients decided to fall out of bed whilst his oesophageal varices burst all over whilst simultaneously bleeding PR despite the 2 HCAs trying to keep him in the bed...and yes! she got coated...Ha! I was rewarded with a Look from one of the senior, senior managers with her- I offered her a set of scrubs and use of the theatre showers (we do not have any other changing facilities in the Trust) and pointed out its a hazard of modern nursing ( not sure when she last touched a patient but certainly not in this century). She countered with a "in my day sisters ran a tight ship, hair above the collar etc etc" I responded with "damn well more than 3 RNs on the floor for 45 acute patients, as I remember and senior so-called nurse managers used to wear a uniform and actually do a bit of hands-on". Stalemate. Any comments on a postcard please sister and it will be filed where it always goes...under B for Bin. They would so love to sack me but no-one in their right mind would take my place and they know it.

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In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.